Skip to main content

Adjuvant radiation for WHO grade II and III intracranial meningiomas: insights on survival and practice patterns from a National Cancer Registry

Journal of Neuro-Oncology volume 149, pages 293–303 (2020)Cite this article

Abstract

Introduction

WHO grades II (atypical) and III (malignant) meningiomas are associated with significant morbidity and mortality. The role of adjuvant radiotherapy (RT) in management remains controversial. The goal of this study was to evaluate the impact of adjuvant RT on 5-year survival in patients with atypical and malignant meningiomas. We secondarily aimed to assess contemporary practice patterns and the impact of sociodemographic factors on outcome.

Methods

We queried the National Cancer Database for patients ≥ 18 years of age with cranial atypical or malignant meningiomas from 2010 through 2015 who underwent surgical resection with or without adjuvant radiotherapy. Subjects with unknown WHO grade or radiation status and those not receiving any surgical procedure were excluded from analysis.

Results

The study includes 7486 patients, 6788 with atypical and 698 with malignant meningiomas. Overall 5-year survival was 76.9% (95% CI 75.5–78.3%) and 43.3% (95% CI 38.8–48.2%) among patients with WHO grades II and III meningiomas, respectively. Adjuvant RT correlated with improved survival in a multivariable model in patients with grade II tumors (HR 0.78; p = 0.029) regardless of the extent of resection. Age (HR 2.33; p < 0.001), male sex (HR 1.27; p < 0.001), Black race (HR 1.27; p = 0.011) and Charlson-Deyo Score ≥ 2 (1.35; p = 0.001) correlated with poorer survival whereas private insurance (HR 0.71; p < 0.001) correlated with improved survival. Adjuvant RT was also associated with improved 5-year survival among those with grade III tumors on univariate analysis (log-rank p = 0.006) but was underpowered for multivariable modeling. Utilization of adjuvant radiotherapy was only 28.4% and correlated with private insurance status. Academic institutions (25.3%) and comprehensive community cancer programs (21.4%) had lower radiotherapy utilization rates compared with integrated network cancer programs (30.5%) and community cancer programs (29.7%).

Conclusions

Adjuvant RT may correlate with improved overall survival in patients with grades II and III intracranial meningiomas regardless of the extent of resection. There is poor utilization of adjuvant RT for patients with grades II and III meningiomas likely due to a paucity of quality data on the subject. These findings will be strengthened with prospective data evaluating the role of adjuvant RT.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Ostrom QT, Gittleman H, Truitt G, Boscia A, Kruchko C, Barnholtz-Sloan JS (2018) CBTRUS Statistical Report: primary brain and other central nervous system tumors diagnosed in the United States in 2011–2015. Neuro Oncol 20(suppl_4):iv1–iv86

    Article  Google Scholar 

  2. Louis DN, Perry A, Reifenberger G et al (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131(6):803–820

    Article  Google Scholar 

  3. Saraf S, McCarthy BJ, Villano JL (2011) Update on meningiomas. Oncologist 16(11):1604–1613

    Article  Google Scholar 

  4. Aghi MK, Carter BS, Cosgrove GR et al (2009) Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery. 64(1):56–60 discussion 60

    Article  Google Scholar 

  5. Sun SQ, Hawasli AH, Huang J, Chicoine MR, Kim AH (2015) An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas. Neurosurg Focus 38(3):E3

    Article  Google Scholar 

  6. Combs SE, Schulz-Ertner D, Debus J, von Deimling A, Hartmann C (2011) Improved correlation of the neuropathologic classification according to adapted world health organization classification and outcome after radiotherapy in patients with atypical and anaplastic meningiomas. Int J Radiat Oncol Biol Phys 81(5):1415–1421

    Article  Google Scholar 

  7. Brodbelt AR, Barclay ME, Greenberg D, Williams M, Jenkinson MD, Karabatsou K (2019) The outcome of patients with surgically treated meningioma in England: 1999–2013. A cancer registry data analysis. Br J Neurosurg 33(6):641–647

    Article  Google Scholar 

  8. Network NCC (2019) Central Nervous System Cancers. NCCN Clinical Practice Guidelines in Oncology Web site. https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf. Accessed 18 Feb 2020

  9. Mair R, Morris K, Scott I, Carroll TA (2011) Radiotherapy for atypical meningiomas. J Neurosurg 115(4):811–819

    Article  Google Scholar 

  10. Boffa DJ, Rosen JE, Mallin K et al (2017) Using the National Cancer Database for outcomes research: a review. JAMA Oncol 3(12):1722–1728

    Article  Google Scholar 

  11. Merkow RP, Rademaker AW, Bilimoria KY (2018) Practical guide to surgical data sets: National Cancer Database (NCDB). JAMA Surg 153(9):850–851

    Article  Google Scholar 

  12. Cancer AcoSCo (2020) About Cancer Program Categories. American College of Surgeons Commission on Cancer. https://www.facs.org/quality-programs/cancer/coc/accreditation/categories. Accessed 3 Mar 2020.

  13. Freedman LS (1982) Tables of the number of patients required in clinical trials using the logrank test. Stat Med 1(2):121–129

    Article  CAS  Google Scholar 

  14. Hsieh FY, Lavori PW (2000) Sample-size calculations for the Cox proportional hazards regression model with nonbinary covariates. Controll Clin Trials 21(6):552–560

    Article  CAS  Google Scholar 

  15. Harrell Jr Fe HJMFEHD. Package "rms" (2017)

  16. Goldbrunner R, Minniti G, Preusser M et al (2016) EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 17(9):e383–391

    Article  Google Scholar 

  17. Bagshaw HP, Burt LM, Jensen RL et al (2017) Adjuvant radiotherapy for atypical meningiomas. J Neurosurg 126(6):1822–1828

    Article  Google Scholar 

  18. Dohm A, McTyre ER, Chan MD et al (2017) Early or late radiotherapy following gross or subtotal resection for atypical meningiomas: clinical outcomes and local control. J Clin Neurosci 46:90–98

    Article  Google Scholar 

  19. Hemmati SM, Ghadjar P, Grun A et al (2019) Adjuvant radiotherapy improves progression-free survival in intracranial atypical meningioma. Radiat Oncol 14(1):160

    Article  Google Scholar 

  20. Zhu H, Bi WL, Aizer A et al (2019) Efficacy of adjuvant radiotherapy for atypical and anaplastic meningioma. Cancer Med 8(1):13–20

    Article  CAS  Google Scholar 

  21. Brown DA, Himes BT, Kerezoudis P et al (2018) Insurance correlates with improved access to care and outcome among glioblastoma patients. Neuro Oncol 20(10):1374–1382

    Article  Google Scholar 

  22. Graffeo CS, Leeper HE, Perry A et al (2017) Revisiting adjuvant radiotherapy after gross total resection of World Health Organization grade II meningioma. World Neurosurg 103:655–663

    Article  Google Scholar 

  23. Masalha W, Heiland DH, Franco P et al (2018) Atypical meningioma: progression-free survival in 161 cases treated at our institution with surgery versus surgery and radiotherapy. J Neurooncol 136(1):147–154

    Article  Google Scholar 

  24. Zeng Q, Shi F, Guo Z (2019) Effectiveness of postoperative radiotherapy on atypical meningioma patients: a population-based study. Front Oncol 9:34

    Article  Google Scholar 

  25. Dawley T, Rana Z, Abou-Al-Shaar H, Goenka A, Schulder M (2019) Major complications from radiotherapy following treatment for atypical meningiomas. Neurosurg Focus 46(6):E5

    Article  Google Scholar 

  26. Weber DC, Ares C, Villa S et al (2018) Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: a phase-II parallel non-randomized and observation study (EORTC 22042–26042). Radiother Oncol 128(2):260–265

    Article  Google Scholar 

  27. Marcus HJ, Price SJ, Wilby M, Santarius T, Kirollos RW (2008) Radiotherapy as an adjuvant in the management of intracranial meningiomas: are we practising evidence-based medicine? Br J Neurosurg 22(4):520–528

    Article  CAS  Google Scholar 

  28. ClinicalTrials.gov (2020) U.S. National Library of Medicine. https://clinicaltrials.gov/ct2/show/NCT03180268. Accessed 3 Mar 2020

  29. Rogers L, Zhang P, Vogelbaum MA, Mehta MP (2018) Erratum. Intermediate-risk meningioma: initial outcomes from NRG oncology RTOG 0539. J Neurosurg. 129(6):1650

    Article  Google Scholar 

  30. Rogers L, Zhang P, Vogelbaum MA et al (2018) Intermediate-risk meningioma: initial outcomes from NRG oncology RTOG 0539. J Neurosurg 129(1):35–47

    Article  Google Scholar 

  31. Lin BJ, Chou KN, Kao HW et al (2014) Correlation between magnetic resonance imaging grading and pathological grading in meningioma. J Neurosurg 121(5):1201–1208

    Article  Google Scholar 

  32. Alghamdi M, Li H, Olivotto I et al (2017) Atypical meningioma: referral patterns, treatment and adherence to guidelines. Can J Neurol Sci 44(3):283–287

    Article  Google Scholar 

  33. Barthelemy E, Loewenstern J, Konuthula N et al (2018) Primary management of atypical meningioma: treatment patterns and survival outcomes by patient age. J Cancer Res Clin Oncol 144(5):969–978

    Article  Google Scholar 

Download references

Acknowledgements

We would like to express gratitude to Paul A. Decker, MS for statistical review of the manuscript.

Funding

This work was unfunded.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA

    Desmond A. Brown, Anshit Goyal, Panagiotis Kerezoudis, Mohammed Ali Alvi, Benjamin T. Himes, Mohamad Bydon, Jamie J. Van Gompel, Terry C. Burns & Ian F. Parney

  2. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA

    Anshit Goyal, Mohammed Ali Alvi & Mohamad Bydon

  3. Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA

    Kaisorn L. Chaichana & Alfredo Quiñones-Hinojosa

  4. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

    Elizabeth Yan

Authors
  1. Desmond A. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anshit Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Panagiotis Kerezoudis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammed Ali Alvi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benjamin T. Himes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohamad Bydon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jamie J. Van Gompel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kaisorn L. Chaichana
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alfredo Quiñones-Hinojosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Terry C. Burns
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Elizabeth Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ian F. Parney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Anshit Goyal or Ian F. Parney.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Brown, D.A., Goyal, A., Kerezoudis, P. et al. Adjuvant radiation for WHO grade II and III intracranial meningiomas: insights on survival and practice patterns from a National Cancer Registry. J Neurooncol 149, 293–303 (2020). https://doi.org/10.1007/s11060-020-03604-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-020-03604-7

Keywords

  • Atypical meningioma
  • Malignant meningioma
  • Adjuvant radiation
  • Extent of resection
  • National Cancer Database